The present invention relates generally to a system which can be used when an interventional procedure is being performed in a stenosed or occluded region of a blood vessel to capture any embolic material that may be created and released into the bloodstream during the procedure. The system of the present invention is particularly useful when performing balloon angioplasty, stenting procedures, laser angioplasty or atherectomy in critical vessels, such as the carotid arteries, where the release of embolic debris into the bloodstream can occlude the flow of oxygenated blood to the brain or other vital organs which can cause devastating consequences to the patient.
A variety of non-surgical interventional procedures have been developed over the years for opening stenosed or occluded blood vessels in a patient caused by the build up of plaque or other substances on the walls of the blood vessel. Such procedures usually involve the percutaneous introduction of the interventional device into the lumen of the artery, usually through a catheter. One widely known and medically accepted procedure is balloon angioplasty in which an inflatable balloon is introduced within the stenosed region of the blood vessel to dilate the occluded vessel. The balloon catheter is initially inserted into the patient""s arterial system and is advanced and manipulated into the area of stenosis in the artery. The balloon is inflated to compress the plaque and press the vessel wall radially outward to increase the diameter of the blood vessel.
Another procedure is laser angioplasty which utilizes a laser to ablate the stenosis by super heating and vaporizing the deposited plaque. Atherectomy is yet another method of treating a stenosed blood vessel in which a cutting blade is rotated to shave the deposited plaque from the arterial wall. A vacuum catheter is usually used to capture the shaved plaque or thrombus from the blood stream during this procedure.
In another widely practiced procedure, the stenosis can be treated by placing a device known as a stent into the stenosed region to hold open and sometimes expand the segment of blood vessel or other arterial lumen. Stents are particularly useful in the treatment or repair of blood vessels after a stenosis has been compressed by percutaneous transluminal coronary angioplasty (PTCA), percutaneous transluminal angioplasty (PTA) or removal by atherectomy or other means. Stents are usually delivered in a compressed condition to the target site, and then are deployed at the target location into an expanded condition to support the vessel and help maintain it in an open position.
Prior art stents typically fall into two general categories of construction. The first type of stent is expandable upon application of a controlled force, often through the inflation of the balloon portion of a dilatation catheter which, upon inflation of the balloon or other expansion means, expands the compressed stent to a larger diameter to be left in place within the artery at the target site. The second type of stent is a self-expanding stent formed from, for example, shape memory metals or super-elastic nickel-titanum (NiTi) alloys, which will automatically expand from a compressed state when the stent is advanced out of the distal end of the delivery catheter into the body lumen. Such stents manufactured from expandable heat sensitive materials allow for phase transformations of the material to occur, resulting in the expansion and contraction of the stent.
The above non-surgical interventional procedures, when successful, avoid the necessity of major surgical operations. However, there is one common problem associated with all of these non-surgical procedures, namely, the potential release of embolic debris into the bloodstream which can occlude distal vasculature and cause significant health problems to the patient. For example, during deployment of a stent, it is possible that the metal struts of the stent can cut into the stenosis and shear off pieces of plaque which become embolic debris that can travel downstream and lodge somewhere in the patient""s vascular system. Pieces of plaque material can sometimes dislodge from the stenosis during a balloon angioplasty procedure and become released into the bloodstream. Additionally, while complete vaporization of plaque is the intended goal during a laser angioplasty procedure, quite often particles are not fully vaporized and enter the bloodstream. Likewise, not all of the emboli created during an atherectomy procedure may be drawn into the vacuum catheter and, as a result, the remaining emboli may enter the bloodstream as well.
When any of the above-described procedures are performed in the cerebral arteries, the release of emboli into the circulatory system can be extremely dangerous and sometimes fatal to the patient. Debris that is carried by the bloodstream to distal vessels of the brain can cause these cerebral vessels to occlude, resulting in a stroke, and in some cases, death. Therefore, although cerebral percutaneous transluminal angioplasty has been performed in the past, the number of procedures performed has been limited due to the justifiable fear of causing an embolic stroke should embolic debris enter the bloodstream and block vital downstream blood passages.
Medical devices have been developed to attempt to deal with the problem created when debris or fragments enter the circulatory system following treatment utilizing any one of the above-identified procedures. One approach which has been attempted is the cutting of any debris into minute sizes which pose little chance of becoming occluded in major vessels within the patient""s vasculature. However, it is often difficult to control the size of the fragments which are formed, and the potential risk of vessel occlusion still exists, making such procedures in the carotid arteries a high-risk proposition.
Other techniques which have been developed to address the problem of removing embolic debris include the use of catheters with a vacuum source which provides temporary suction to remove embolic debris from the bloodstream. However, as mentioned above, there have been complications with such systems since the vacuum catheter may not always remove all of the embolic material from the bloodstream, and a powerful suction could cause problems to the patient""s vasculature. Further techniques which have had some limited success include the placement of a filter or trap downstream from the treatment site to capture embolic debris before it reaches the smaller blood vessels downstream. However, there have been problems associated with filtering systems, particularly during the expansion and collapsing of the filter within the body vessel. If the filtering device does not have a suitable mechanism for closing the filter, there is a possibility that trapped embolic debris can backflow through the open end of the filter and enter the bloodstream as the filtering system is being collapsed for removal from the patient. In such a case, the act of collapsing the filter device may actually squeeze trapped embolic material through the opening of the filter. In other instances, the rate of blood percolating through the filtering material may be slower than the normal blood flow which can either cause the filtering material to tear or cause the filter to become displaced with the vessel due to the build up of fluid pressure behind the filter. Moreover, should the filter become clogged with debris, there is a possibility that blood circulation past the clogged filter will be insufficient for the downstream vessels and organs. If a filter should become clogged when in use in the carotid arteries, blood flow could be diminished to the vessels leading to the brain. While the brain may be capable of functioning for a short period of time without sufficient blood flow, blood stoppage of more than thirty to forty seconds could cause the patient to experience a seizure. If the physician administering the procedure is unaware that the filtering device is clogged and that there is little or no blood flowing to the brain, the injury to the patient can be as devastating as if an emboli itself had caused blockage of the cerebral arteries.
What has been needed is a reliable system and method for treating stenosis in blood vessels which prevent the risk of releasing embolic debris into the bloodstream that can cause blockage in vessels at downstream locations. The system and method should be capable of filtering any embolic debris which may be released into the bloodstream during the treatment, and yet allow a sufficient amount of oxygenated blood to flow past the filtering device to supply vital organs downstream from the treatment site. The system and method should be relatively easy for a physician to use and should provide a failsafe filtering system which removes all embolic debris from the bloodstream. Moreover, such a system should be relatively easy to deploy and remove from the patient""s vasculature. The inventions disclosed herein satisfy all of these needs.
The present invention provides a system and method for capturing embolic debris in a blood vessel which may be created during the performance of a therapeutic interventional procedure, such as a balloon angioplasty or stenting procedure, in order to prevent the embolic debris from lodging and blocking blood vessels downstream from the interventional site. The present invention is particularly useful while performing an interventional procedure in vital arteries, such as the carotid arteries, in which critical downstream blood vessels can become blocked with embolic debris, including the main blood vessels leading to the brain or other vital organs. As a result, the present invention provides the physician with a higher degree of confidence that any and all embolic debris is being collected and removed from the blood vessel when performing high-risk interventional procedures.
The present invention occludes the blood vessel at a location distal to or at the area of treatment in the interventional procedure site, perfuses the blood to enable blood to flow past the occlusion, and filters the blood to capture any embolic debris which may be created during the interventional procedure.
In the present invention, the system includes an emboli-capturing catheter with an occlusion balloon to occlude a blood vessel, a plurality of perfusion openings to perfuse the blood past the occlusion, and filter media to capture embolic material. The emboli-capturing catheter of the present invention directs the blood flow through the area where the interventional procedure is to be performed and through the filter media located relative to the interventional site, which are designed to capture any friable plaque deposits. Additionally, the present invention allows blood to perfuse past the filter media to provide a continuous stream of blood to the organs located downstream.
In one particular embodiment of the present invention, the embolic protection system includes an emboli-capturing catheter which includes an elongated catheter body which has a proximal and distal end along with a main lumen which extends through the catheter body. An expandable member, such as an inflatable balloon, located near the distal end of the elongated catheter body, is in fluid communication with an inflation lumen. Upon inflation with a suitable fluid, the expandable member can be deployed within the blood vessel to prevent blood flow past the expandable member, for occluding the blood vessel at a location distal to the interventional procedure site. A plurality of perfusion openings in the elongated catheter body include inlet openings located proximal to the expandable member which extend into the main lumen, and an outlet opening or a plurality of outlet openings located at the distal end portion of the catheter body. As a result, even though the expandable member occludes the blood vessel, the blood will continue to flow into the catheter body through the perfusion inlet openings and through the perfusion lumen past the expandable member and out the perfusion outlet opening or openings. The blood flowing through the perfusion inlet openings and the catheter body lumen directs any embolic debris into the filter media positioned internally in the distal end portion of the catheter body and distal of the interventional site, for capturing embolic material which may be released into the blood in the blood vessel during the interventional procedure.
In another particular embodiment of the present invention, the embolic protection system includes an emboli-capturing catheter including an elongated catheter body having proximal and distal ends and a main lumen extending therethrough. The catheter further includes an expandable member, adapted to be inflated and deployed at the area of treatment to occlude the blood vessel and to prevent emboli from forming and being released from the area of treatment prior to deployment of filter media. The catheter also includes a plurality of perfusion openings for enabling the blood to continue to flow through the catheter body and out a distal end opening therein for perfusion of the blood. The catheter still further includes filter media adapted to be deployed externally of the catheter body for capturing embolic material which may be released into the bloodstream upon deflation of the expandable member and during the interventional procedure.
The elongated shaft of the emboli-capturing catheter, once deployed within the patient""s vasculature, can be used as a guidewire to allow interventional instruments to be moved along the elongated shaft into the area of treatment in an over-the-wire arrangement. This eliminates the need to maintain a separate guidewire in the patient once the emboli-capturing catheter is in place.
Other features and advantages of the present invention will become more apparent from the following detailed description of the preferred embodiments of the invention, when taken in conjunction with the accompanying exemplary drawings.